Healthcare Provider Details

I. General information

NPI: 1801235502
Provider Name (Legal Business Name): LLHC ST. GEORGE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2013
Last Update Date: 06/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 W 1470 S
ST GEORGE UT
84770-6798
US

IV. Provider business mailing address

120 W 1470 S
ST GEORGE UT
84770-6798
US

V. Phone/Fax

Practice location:
  • Phone: 435-574-9777
  • Fax:
Mailing address:
  • Phone: 435-574-9777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number7300098-1205
License Number StateUT

VIII. Authorized Official

Name: MR. RONALD DAVID TILLER
Title or Position: MEDICAL DIRECTOR
Credential: P.A.
Phone: 435-574-9777